Fluid on the head spud... thanks for all of your comments! Dad was mad at me when he first called from the car. Mom had called and spoken with my nurse a few minutes before. On my hearing that he was fine, that simply the fluid collection seemed a little bigger, my thought was to get the CCT and then see him a couple of hours later in the office. This is what my nurse told mom. Dad called as they were driving to the ED so I took the call. He told me, "How could you possibly say he was fine? We're taking him to the ER!" My unequivocal answer was I felt he was fine because they had told me he was. And there were no worrisome answers to my usual questions... I asked him if why he thought this was emergent: was I missing something? He realized that there really wasn't anything emergent, and agreed to do the CCT instead of the ED. I agreed to see them as soon as the CCT was done (I actually went over as the hospital is conveniently in the next building over and reviewed the CCT myself and examined the spud). I told them I had no firm idea what this was, that it most likely was a hematoma even if we didn't have a story to go with it (on CCT it was not dark like the CSF spaces so we were fairly sure it didn't communicate, and that it probably wasn't CSF). I felt that since there was no intracranial communication, no damage and he was otherwise fine, that we should be able to watch this until he either gave us more clues or it went away. Common things happen commonly, or bad things happen rarely. I still think the most likely thing is a hematoma (though Mike makes me really want to tap it to find out, I shall resist the urge to do so...). Additionally, I told them I had not rested my case, that I had consulted with some folks at the local big university medical center, and that they were scratching their heads as well. I further mentioned I would be contacting others (including Pedtalk) to see if anyone else had seen this sort of thing (like Mike Webster). I stressed that I thought there was no indication that this was an aggressive process, and openly wondered if he got innocently bonked on the bean. They have been a little tense to begin with (in the previous well child visits). It was Dad who gave me the evil eye and made it clear without saying so that they were not impressed with me nor my efforts... To their credit, the mother's mom had just been diagnosed with bad cancer and they were trying to make their way to her hospital in Boston... they are probably quite stressed. I also wondered if their was some blaming going on, but couldn't read this well. The closest Dad came to an apology was in saying that "you have kids, you've gotta know how hard this is to accept." Uh, yes and no... I see this when people fail to understand that what they want is not necessarily what they need, and don't want to hear that what they need is not what they want... (aka the antibiotic for the cold debate). I always thought it funny that no one treats the car mechanic or plumber with this open disdain. I sometimes marvel at how people could think that as a pediatrician I couldn't possibly have their child's best interest at heart. I am being calmly supportive, have made myself very available and made it clear that I would not bamboozle them if I didn't find any answers. I did have to work consciously not to panic, feeling their stress and having no idea what this was. I relied on the usual "treat the baby, not the lab", and since he was minding his own business, I thought I should too. Besides, he smiled at me and he's damn cute. But they still hate me, just because... BTW, anyone else seen the Webster association, as I have formally dubbed this? (I think this kid has what Mike's patients had). Ken Schroeter, DO, FAAP Professional Website: http://sites.netscape.net/kenschroeter/ LR Peds: http://www.lakesregionpediatrics.medem.com "Trying is the first step towards failure!" - Homer Simpson